Hormone Replacement Therapy (HRT) has become a pivotal treatment for those undergoing menopausal changes, as well as for transgender individuals during their transition. A popular form of administering HRT is through transdermal gels, which are absorbed through the skin. However, it's essential to understand that certain factors can affect the absorption of these gels, potentially impacting the efficacy of the treatment. This blog delves into some key factors that can influence HRT gel absorption and concludes with tips to enhance its efficacy.

Skin Condition

The condition of your skin plays a crucial role in HRT gel absorption. Dry, damaged, or irritated skin can hinder the gel's ability to penetrate effectively. A study published in the Journal of Clinical Pharmacology highlights that hydrated and healthy skin can absorb medications more efficiently than compromised skin. It's therefore essential to maintain good skin health to ensure optimal absorption.

Application Area

The human skin is not uniform in thickness across the body. Areas like the inner thighs and arms tend to have thinner skin compared to other parts, such as the palms or soles of the feet. Thinner skin has fewer layers for the gel to penetrate, making the absorption process more efficient. Additionally, these areas usually have a higher density of blood vessels close to the surface of the skin, which facilitates quicker and more effective absorption of the medication into the bloodstream.

The recommendation by the British Menopause Society to apply HRT gels to the inner thighs or arms is based on a combination of factors:

• Increased Absorption Rate: As mentioned, the thinner skin and better blood flow in these areas allow for a more efficient absorption rate. This ensures that a higher percentage of the hormone dose reaches the bloodstream, making the treatment more effective.
• Reduced Risk of Transfer: Applying the gel to areas that are less likely to come into contact with others reduces the risk of accidentally transferring the medication. For example, applying the gel on the inner thighs or arms minimises the risk of transferring hormones to children or pets, a concern that might be more prevalent if applied to hands or other frequently exposed areas.
• Comfort and Convenience: These areas are not only effective in terms of absorption but are also more convenient and comfortable for application. They are easy to reach and can be covered with clothing, reducing the risk of the gel rubbing off or being washed away prematurely.

Physical Activity Post-Application

When you apply an HRT gel to your skin, it needs sufficient time to dry and be absorbed properly. Engaging in physical activities immediately after application can hinder this process in several ways:

• Spreading of the Gel: Vigorous movement can cause the gel to spread beyond the intended application area. This not only reduces the amount of medication absorbed in the correct area but can also lead to unintentional absorption in other parts of the body.
• Sweating: Exercise-induced sweating can interfere with the absorption process. Sweat can mix with the gel, diluting its concentration and potentially washing it off the skin before it has been fully absorbed. This reduces the amount of medication that enters the bloodstream and can lead to inconsistent dosing.
• Wiping Off the Medication: During physical activity, there's a tendency to touch or wipe the area where the gel has been applied, either consciously or unconsciously. This action can remove the gel from the skin, decreasing the effective dose absorbed.

The Endocrine Society's recommendation to wait for the gel to dry completely before engaging in physical activity is based on ensuring optimal absorption. The drying time can vary depending on the specific product and the environment, but it generally takes a few minutes.

Exposure to Water

The primary concern with water exposure soon after applying HRT gel is the risk of washing off the medication before it has been fully absorbed into the skin. This can significantly reduce the effectiveness of the treatment for several reasons:

• Immediate Washing Off: Water can immediately rinse away the gel if it hasn't had enough time to dry and be absorbed. This is particularly relevant for activities like swimming or taking a shower, where the application area is directly exposed to water.
• Dilution of the Medication: Even if the gel has dried to some extent, prolonged or intense water exposure can still dilute the medication, reducing its concentration and thereby its efficacy.
• Reduced Absorption Time: The gel requires adequate time to penetrate the skin and enter the bloodstream. Water exposure interrupts this process, potentially leading to inconsistent dosing and reduced therapeutic effects.

The National Health Service (NHS) recommends waiting for a specific period, typically about an hour, after applying HRT gel before engaging in water-related activities. This guideline is designed to ensure that the gel has enough time to be absorbed properly into the skin.

Interaction with Other Skin Products

The use of other skin products, like lotions, creams, or oils, can interfere with the absorption of HRT gels. These products can create a barrier on the skin, reducing the gel's ability to penetrate. The American Academy of Dermatology recommends applying HRT gels on clean skin and waiting for some time before using any other skin products.

More recently, research has started on a potential link between harmful chemicals found in synthetic fragrances of body care products, such as soap, and reduced HRT absorption. It’s believed that the chemicals interfere with the HRT gel's efficacy. At Quiet Blue, we’re proud of our commitment to natural products, free of hormone disrupting toxins and chemicals. Our product range is made with menopause and PCOS in mind. 

Tips to Improve HRT Absorption

To maximise the benefits of HRT gels, consider the following tips:

• Maintain Healthy Skin: Regularly moisturise your skin to keep it hydrated but ensure that your skin is completely dry and free from other products before applying the HRT gel.
• Apply Correctly: Follow the specific instructions for application, including the recommended body areas and the amount of gel to use.
• Avoid Water and Excessive Activity Immediately After Application: Give the gel ample time to absorb before engaging in activities that could interfere with absorption.
• Consistent Routine: Apply your HRT gel at the same time each day to maintain consistent hormone levels in your body.
• Consult with Your Healthcare Provider: Regularly discuss your HRT treatment with your healthcare provider to ensure it's working effectively and make any necessary adjustments.

In conclusion, while transdermal HRT gels offer a convenient and effective way to administer hormone therapy, it's crucial to be aware of factors that can impact their absorption. By understanding these elements and adopting practices to enhance absorption, you can ensure that you're getting the most out of your HRT treatment.